This invention relates equol and its mechanism of action and use as a therapeutic compound for treating and preventing physiological and pathophysiological conditions mediated by androgens.
In recent years phytoestrogens have received increased investigative attention due to their potential protective effects against age-related diseases (e.g. cardiovascular disease and osteoporosis) and hormone-dependent cancers (i.e., breast and prostate cancer). There are three main classifications of phytoestrogens: 1) isoflavones (derived principally from soybeans), 2) lignans (found in flaxseed in large quantities) and 3) coumestans (derived from sprouting plants like alfalfa). Of these three main classifications, human consumption of isoflavones has the largest impact due to its availability and variety in food products containing soy. Of the isoflavones, genistein and daidzein are thought to exert the most potent estrogenic hormone activity and thus most attention has been directed toward these molecules (Knight et al, Obstet Gyneco, 187:897-904, (1996); Setchell, K D R. Am J Clin Nutr, 129:1333 S-1346S (1998); Kurzer et al, Annu Rev Nutr, 17:353-381 (1997)). However, these isoflavone molecules do not exist at high levels in their biologically active form in soy foods, but rather are at high abundance in a precursor form. For example, genistin, the precursor of genistein, is the glycosidic form that contains a carbohydrate portion of the molecule. Additionally, malonylglucoside and acetylglucoside forms also are found. These conjugates are metabolized in the gastrointestinal (GI) tract by intestinal bacteria, which hydrolyze the carbohydrate moiety to the biologically active phytoestrogen, genistein. The same metabolic step occurs for the aglycone daidzein, which is converted from the glycosidic form daidzin. Diadzein is then further metabolized to equol in an “equol-producing” mammal, which is then found in the plasma of an equol-producing individual. Equol is not normally present in the urine of most healthy human adults unless soy is consumed. The formation of equol in vivo is exclusively dependent on intestinal microflora as evidenced from the finding that germ-free and phytoestrogen-free fed animals do not excrete equol when fed soy, and that equol is not found in the plasma and urine of human newborn or 4-month old infants fed exclusively soy foods from birth due to the fact that the intestinal flora has not yet developed in neonates. (See Setchell et al, The Lancet, 1997; 350:23-27).
The phenolic ring structures of isoflavones enable these compounds to bind estrogen receptors (ER) and mimic estrogen. Although genistein and daidzein bind to ER, it is with a lower affinity when compared to estradiol, and with a greater affinity for ERβ than to ERα. Thus isoflavones, like genistein and the metabolite S-equol, act like natural selective estrogen receptor modulators (SERMs) at various tissue sites throughout the body. In some tissues, there is evidence that phytoestrogens act as estrogen agonists, whereas in others, they display antagonistic characteristics comparable to that of tamoxifen or raloxifene where SERM activity appears to be sex-hormone- and gender-dependent.
While the bulk of the scientific literature has focused on the natural isoflavones in soy or clover, little has been reported on the actions or effects of their intestinally derived metabolites. Equol (7-hydroxy-3(4′hydroxyphenyl)-chroman) represents the major metabolite of the phytoestrogen daidzin, one of the main isoflavones found abundantly in soybeans and soy-foods. Equol, however, is not a phytoestrogen, because it is not a natural constituent of plants. Equol does not occur naturally in any plant-based products. Rather, it is a non-steroidal isoflavone that is exclusively a product of intestinal bacterial metabolism, however, only about 30-40% of humans have the microflora necessary to convert soy isoflavones to equol.
Previous research with equol has identified that equol possesses some weak estrogenic properties, binds sex hormone binding globulin and α-fetoprotein, and has antioxidant activity. The S-enantiomer of equol (S-)-equol) is the exclusive equol form found in the urine and plasma of “equol-producing” mammals consuming soy, and is the only equol enantiomer made by human intestinal bacteria. The R- and S-enantiomers conformationally differ, which subsequently influences their biological activity. For example, only the S-enantiomer of equol binds ER subtypes with sufficient affinity to be relevant to usual circulating equol levels reported in humans.
The prostate gland depends on androgen hormone action for its development and growth, and the development of human benign prostatic hyperplasia (BPH) clearly requires a combination of testicular androgens during the aging process. However, testosterone is not the major androgen responsible for growth of the prostate. The principal prostatic androgen is 5α-dihydrotestosterone (5α-DHT), as evidenced by current treatments of prostatic cancer, which are directed toward reducing 5α-DHT with 5α-reductase inhibitors. Although not elevated in human BPH, 5α-DHT levels in the prostate remain at a constant with aging, despite a decrease in the plasma testosterone concentration. Testosterone is converted to 5α-DHT by 5α-reductase in prostatic stromal and basal cells. 5α-DHT is primarily responsible for prostate development and the pathogenesis of BPH. Inhibitors of 5α-reductase reduce prostate size by 20% to 30%. This reduction in glandular tissue is achieved by the induction of apoptosis, which is histologically manifested by ductal atrophy. 5α-reductase occurs as 2 isoforms, type 1 and type 2, with the prostate expressing predominantly the type-2 isoform, and the liver and skin expressing primarily the type-1 isoform. Patients have been identified with deficiencies in the type-2 5α-reductase, but not type 1. Gene-targeted knockout mice with the type-2 5α-reductase null-mutation demonstrate a phenotype similar to that seen in men with 5α-reductase deficiency. Type-15α-reductase knockout male mice are phenotypically normal with respect to reproductive function. Enzymatic activity for 5α-reductase or immunohistochemical detection has been noted in other genitourinary tissues, such as the epididymis, testes, gubernaculum, and corporal cavernosal tissue.
Quantitatively, women secrete greater amounts of androgen than that of estrogen due to the greater adrenal cortical responsiveness by gender. The major circulating steroids generally classified as androgens include dehydroepiandrosterone sulphate (DHEAS), dehydroepiandrosterone (DHEA) (originating from the adrenal cortex), androstenedione (A), testosterone (T), and 5α-DHT in descending order of serum concentration, though only the latter two bind the androgen receptor to a significant degree. The other three steroids are better considered as pro-androgens. 5α-DHT is primarily a peripheral product of testosterone metabolism. Testosterone circulates both in its free form, and bound to protein including albumin and sex steroid hormone-binding globulin (SHBG), the levels of which are an important determinant of free testosterone concentration. The postmenopausal ovary is an androgen-secreting organ and the levels of testosterone are not directly influenced by the menopausal transition or the occurrence of menopause.
The work of some research has focused on the development of steroidal compounds for the treatment of androgen dependent diseases such as: hirsutism, androgenic alopecia, benign prostatic hyperplasia (BPH) and prostate cancer. DHT has been implicated as a causative factor in the progression of these diseases, largely through the clinical evaluation of males who are genetically deficient of steroid 5α-reductase enzyme. As a result of such studies, the inhibition of this enzyme has become a pharmacological strategy for the design and synthesis of new antiandrogenic drugs. However, it is unclear whether inhibition of 5α-reductase will have a deleterious impact on the system, as evidenced by contraindications arising from reported side effects of conventional treatments using 5α-reducatse inhibitors, such as decreased libido, erectile dysfunction and ejaculatory disorders. The development of different strategies that target the inhibition of DHT effects would be a major advance in the therapy of androgen-mediated conditions.
Despite the recent gains in understanding the pharmacology of equol as it pertains to estrogen actions, our research showing potent antiandrogen effects of equol is unique and novel and opens new approaches to preventing or treating androgen-related conditions. Binding or sequestering 5α-DHT would provide a means for inhibiting its effect on 5α-DHT-sensitive tissues. There is no known ligand that is specific for 5α-DHT, but such an agent would have distinct advantages over non-discriminatory compounds that target the androgen receptor directly or the enzymes involved in androgen synthesis.